Scoping review of patient-centered care approaches in healthcare

How obstetricians experience stillbirth and perinatal loss: a systematic review and meta-synthesis

Objective

Globally, ∼2 million babies are stillborn annually, many in low- and middle-income countries. We aim to understand the experience of obstetricians caring for parents who experience stillbirth and perinatal loss across global settings.

Data Sources

: Medline via Ovid, Embase via Ovid, CINAHL via Ebsco, PsychINFO via Ebsco, Scopus, Web of Science Core Collection, and ASSIA via Proquest were searched, database inception-June 2024.

Study Eligibility Criteria

Studies with qualitative components describing experiences of obstetricians providing stillbirth care in any global setting.

Study Appraisal and Synthesis Methods

The Critical Appraisal Skills Programme checklist for qualitative research was utilized to conduct quality assessment. NVivo software was employed for inductive coding and thematic analysis.

Results

Thirteen qualitative studies from both low- and high-resource settings met the inclusion criteria for meta-synthesis. We identified several major themes including the emotional burdens experienced by obstetricians providing stillbirth care, the challenges of patient-provider interactions following adverse outcomes, and a lack of support and resources. Obstetricians across global settings felt devastation, guilt, blame, and a sense of personal responsibility following stillbirth. Obstetricians struggled to navigate the burden of expectation placed on their overall provision of care and tended to question their own professional competence. A subset of obstetricians felt unprepared for the complexity of patient-provider interactions following stillbirth.

Conclusions

Obstetricians experienced complex and conflicting emotions, citing high emotional burden from managing stillbirth cases. Obstetricians identified lack of training and support for providing bereavement care across healthcare settings, indicating a gap that should be filled by stillbirth and bereavement care interventions and education in obstetrical training programs across global settings. Infrastructure for bereavement care training and support systems for obstetricians are crucial to improve the quality of stillbirth and perinatal loss care and prevent an exodus of needed providers for women's care worldwide.

Patient and caregiver perceptions of oxygen therapy in facility-based settings for acute hypoxemic conditions: a scoping review

Background

Access to oxygen therapy is essential for ensuring a functioning health care system. Despite its widespread application across multiple patient groups and all ages, there is a lack of understanding about community perceptions and experiences while receiving oxygen therapy for acute conditions. We aimed to understand patient and caregiver perceptions of oxygen therapy in facility-based settings for acute hypoxemic conditions.

Methods

We conducted a scoping review. We searched Medline, Embase, and Web of Science (26 February 2024) for original studies published since 2000 relating to patient or caregiver perceptions and experiences of oxygen for an acute medical need in health facility settings. We used an adapted theoretical framework of acceptability to extract and structure the findings.

Results

Searches returned 10 425 unique records, and 25 articles were included. 20 were from high-income countries, and 18 were qualitative studies. The results showed that patient and caregiver attitudes and feelings about oxygen therapy are strongly influenced by perceived effectiveness, which was almost universally positive. Patients and their caregivers suffer different types of burdens, and these are greater for more advanced respiratory therapies than for simple oxygen therapy. Patient and caregiver understanding of oxygen therapy was low, presenting an opportunity for improved communication. Opportunity costs were highest in caregivers of neonates, who were often separated from their infants for long periods, and out-of-pocket costs were a major consideration in low- and middle-income countries.

Conclusions

In this scoping review, we found distinctions in caregiver and patient burden, and their perspectives of oxygen varied between country income. Intervention coherence - the extent to which the patient and their caregivers understand the treatment - was singled out as the key policy area for improvement. Educational campaigns, like those implemented for previous public health emergencies, could lead to increased public knowledge, and thus acceptability, of oxygen therapy.

Developing an intervention to improve early infant HIV diagnosis service uptake among postpartum women in Malawi's primary healthcare using a co-designing approach with stakeholders

Low health service use by women and infants after birth limits early infant HIV diagnosis (EID). From August 2021 to December 2022, we collaborated with 44 healthcare workers (HCW), service users, and non-governmental organisation stakeholders from seven public facilities and five non-governmental organisations in Blantyre, building on a previous study. We analysed context-specific problems in EID services and co-designed a context-appropriate enhanced health system intervention to improve the uptake of six weeks' EID services in primary health facilities in Blantyre, Malawi, using qualitative methods and co-designing workshops. The Behaviour Change Wheel, Theoretical Domain Framework and Consolidated Framework for sustainability constructs in healthcare guided the workshops. Reflexive thematic analysis of the data showed that stakeholders found that EID services were sub-optimal and identified challenges to service provision in 5 key areas: (1) client identification, (2) context-appropriate client-centred service integration, (3) HCW coordination and accountability, (4) HCW capacity building for optimal service delivery, and (5) intervention sustainability. Specifically, client and HCW stigma perceptions, referral gaps, resource challenges, HCW lack of time and poor documentation affected client identification; HCW clustered work shifts to extend off-duty periods, failure to synchronise client appointments, and lack of resources were barriers to client-centred integrated services; dysfunctional teams, minimal supervision and misconduct among HCW impacted coordination and accountability; and lack of information sharing and limited training reduced HCW capacity for service delivery. Context-appropriate stakeholder informed co-design initiatives to address identified challenges included: clients' unique identifiers, booking systems, strengthening leadership, data validation, care pathways, and facility-based training. We recommend evaluating these initiatives in low resource settings as they have potential to address the identified EID service implementation gaps and significantly improve the EID of HIV in contexts of greatest need.

Gothenburg direct observation tool for assessing person-centred care (GDOT-PCC): evaluation of inter-rater reliability

OBJECTIVE

To assess the inter-rater reliability of the Gothenburg direct observation tool-person-centred care in assessing healthcare professionals' competency in delivering person-centred care (PCC).

DESIGN

Observational, fully-crossed inter-rater reliability study.

SETTING

The study was conducted between October and December 2022 at the participants' homes or offices.

PARTICIPANTS AND METHODS

Six health professionals individually rated 10 video-recorded, simulated consultations against the 53-item, 15-domain tool covering four major areas: PCC activities, clinician manner, clinician skills and PCC goals. Cronbach's α was used to assess internal consistency. Intraclass correlations (ICC) and 95% CI were computed for the domains.

RESULTS

Two domains (planning and documentation and documentation) were excluded from analyses due to insufficient evaluable data. Cronbach's α was acceptable (>0.70) for all evaluated domains. ICC values were high (ICC ≥0.75) for 11 of the 13 domains; however, CIs were generally wide and the lower bounds fell within the good range (ICC=0.60-0.74) for six domains and fair agreement (ICC=0.40-0.59) for the remaining six. The ICC for the domain patient perspective was non-informative due to its wide CIs (ICC=0.74 (0.39-0.92)).

CONCLUSION

ICC estimates for most domains were comparable to or exceeded those reported for similar direct observation tools for assessing PCC, suggesting that they may reliably be used in, for example, education and quality improvement applications. Reliability for the domains planning and documentation and documentation needs to be assessed in studies sampling more documentation behaviours. Reliability for the patient perspective domain may owe to methodological issues and should be reassessed in larger, better-designed studies.

Exploring empathy and patient-centered communication behaviors of third-year medical students during a clinical skills examination

A previous study of third-year medical students' empathy during a clinical skills assessment found that SPs rated female students higher than males, and male Black/African-Americans received the lowest empathy scores. Our objective was to analyze students' patient-centered communication behaviors (PCCBs) to better understand those reported gender and racial/ethnic differences in empathy scores.

METHODS

We examined 63 videos from the parent study, using discourse and content analysis to identify PCCBs during standardized patient (SP) encounters. Then, we determined which PCCBs significantly correlated with SP empathy ratings. Finally, we examined whether those significant PCCBs differed across third-year medical students' gender and race/ethnicity.

RESULTS

We identified 18 PCCBs, six of which significantly correlated with SP empathy ratings. Generally, women tended to use patient-centered communication than men, while Black/African American men used less than Asian/Pacific Islander or white men.

CONCLUSION

In this exploratory, multiple methods study, we analyzed student discourse to better understand the reported gender and racial/ethnic differences in SP empathy scores. We found suggestions of gender and racial differences in behaviors related to patient-centered communication that need to be confirmed in larger, better-powered studies.

PRACTICE IMPLICATIONS

If our findings are corroborated, understanding gender and race/ethnicity differences in PCCBs may help medical educators teach students patient-centered communication (PCC) in a more diverse, culturally situated way. Beneficial actions would include developing faculty to teach PCC with a multi-cultural emphasis and recruiting more minority faculty in our medical schools to model effective communication and empathy skills. In addition, the PCCBs we identified through discourse analysis in this study can provide educators with a tool for teaching doctor-patient communication. Educators can review students' video encounters to provide specific and actionable feedback to promote PCC and empathy.

Decision aid development for shared surgical decision-making in differences of sex development: A review of existing aids

BACKGROUND

For some children with differences of sex development (DSD), surgical intervention is a potential treatment option to address risk of neoplasia or potential for difficulties with urination. The shared decision-making (SDM) process can be challenging for patients, families, and clinicians; decision aids (DAs) can assist in this process.

OBJECTIVE

To conduct a narrative review of literature relevant to the use of DAs in surgical SDM for children with DSD, and to provide a framework for providers to create and implement DAs alongside key stakeholders.

METHODS

Primary and secondary literature searches were conducted using PubMed to generate a narrative literature review, which informed a framework incorporating aspects of community-based participatory research.

RESULTS

Six publications were included in the narrative review. Effective DAs were noted to include the following core components: (1) an overview of the process and the family's goals and values, (2) a review of nomenclature, (3) a list of topics and desired depth of discussion for each, (4) a list of questions for the medical team, and (5) management options including non-surgical management. A framework of key components and steps for future DA development was constructed based on the findings of the reviewed publications.

CONCLUSION

Our framework for a community-based participatory research approach to the development of DAs for surgical SDM for children with DSD provides a critical tool for clinicians to ensure patients and their caregivers are well-informed about their diagnoses and treatment options. Future research should further assess implementation and effectiveness of DAs.

The power paradox of patient-centred care in Chinese community health: Towards a conceptualisation

Patient-centred care (PCC) is widely heralded as a transformative healthcare paradigm, designed to prioritise patients' unique needs, preferences, and values in clinical decision-making. By potentially shifting away from the historically provider-centric model, PCC aims to empower patients as autonomous, active participants. However, critical questions remain: Does PCC genuinely dismantle power asymmetries, or does it merely serve as rhetoric subtly reinforcing existing hierarchies under the guise of empowerment? This study examines this power paradox-the disconnect between PCC's rhetorical positioning and its superficial implementation-through Steven Lukes' three dimensions of power, focusing on China's community healthcare system, where patient-centred ideals are strongly advocated. A year-long non-participant observation at a major community health centre in Shenzhen, complemented by semi-structured interviews with 16 general practitioners (GPs) and 18 hypertensive patients (HPs), informed an iterative thematic analysis. The analysis identified three paradoxes that complicate PCC's vision of patient empowerment. First, protective authority demonstrates how GPs' protective intentions manifest as directive behaviours, fostering dependency and limiting patient agency. Second, framing authority reveals how organisational norms, policies, and clinical expectations constrain patient choice, prioritising compliance over autonomy. Lastly, internalised compliance highlights PCC's ideological power, where HPs internalise adherence as integral to their identity as 'good' patients, embedding deference to medical authority within their sense of well-being. These findings offer critical insights into PCC's power paradox, questioning its theoretical capacity to redress entrenched provider-patient power imbalances. Addressing these challenges necessitates systemic reforms and shifts in clinical practice to genuinely prioritise patient-centredness.

Your right to choose: parents' preferences toward a pediatric dental center

BACKGROUND

Timely dental care during childhood can effectively prevent many dental issues and their potential long-term complications.

AIM

To identify factors associated with the selection of clinics providing dental care and services for children from parental perspective.

DESIGN METHOD

A thematic qualitative study was conducted, involving parents of children aged 6-12 years who visited pediatric dentists in public/private dental centers in Isfahan city from December 2022 to July 2023. Twenty semi-structured face-to-face interviews were conducted in private rooms within the selected centers. A thematic analysis method was used to analyze interview transcripts.

RESULTS

Seven main theme and 20 sub-themes were identified. They included accessibility (geographical location, proximity to residential area, parking), familiarity with pediatric dental center (recommendations from other dentists, recommendations from other patients, previous visits), amenities (general amenities, visual amenities), appointment arrangements (center's working hours, waiting queue, appointment booking), treatment cost (tariffs of dental care and services, installment plans, contracts with insurance companies), quality of medical equipment (supervision over treatment, quality of dental materials, diagnostic equipment, adherence to hygiene protocols), and staff (administrative and treatment staff). Treatment cost (tariffs of dental care and services, installment plans, contracts with insurance companies).

CONCLUSION

Parents consider various aspects of pediatric dental centers to select ones that best in line with their priorities and needs. Specifically, parents focus on both financial aspects of pediatric treatments-and non-financial considerations.

Communication and relationships: how patients perceive informational and interactional organizational justice can improve patient-centered care, a study with samples from Spain and the U.S

BACKGROUND

Organizational variables as perceived organizational justice can influence patients' behaviors. After analyzing the three tenants of patient-centered care (i.e., communication, relationships and health promotion), we identified a gap regarding how patients' attitudes and organizational perceptions contribute to enhancing the effectiveness of patient-centered care. This study aims to improve the understanding of patients' experiences with health care organizations to enable health care service management to enhance patient-centered care quality. Given the structural differences in healthcare systems in Spain and the U.S., we examined both contexts to strengthen our analysis of patient perceptions that are critical for improving patient-centered care across different systems.

METHODS

We conducted a cross-sectional survey study using two data samples from Spain and the U.S. We tested the role of patients perceived interactional and informational organizational justice in health service performance with respect to patients' behaviors of adhering to professional advice and loyalty to the service. The final sample comprised 473 health care users from Spain (male 59.2%) and 406 from the U.S. (male 52.0%), all aged 18 or older. In Spain, we developed a random sample selection from patients that visited their primary care service onsite. In the U.S., patients were invited to participate though an online survey platform that randomly selected participants from their panel database of the general population. In both samples the participants had visited a healthcare service within the past six months. We assessed perceived organizational justice (interactional and informational), adherence to professional advice, and loyalty to the service, and the mediating role of trust in healthcare providers and satisfaction with services.

RESULTS

Significant correlations were found in both samples for each justice dimension with both behaviors: adherence to advise (interactional, r = 0.15/0.18, p < 0.01; informational, r = 0.19/0.19, p < 0.01) and loyalty to the service (interactional, r = 0.45/0.79, p < 0.01; informational, r = 0.45/0.70, p < 0.01). When we tested the model that included mediating patients' attitudes of trust and satisfaction, we found that the direct relationship between informational justice and adherence still held (standardized trajectory coefficient = 0.13, p < 0.01) showing their consolidated relationship. For interactional fairness, trust and satisfaction significantly mediated the relationship with adherence. On the other hand, the relationships between both justices and patient loyalty to the service were always partially mediated by patient trust and satisfaction (model fit for interactional justice perceptions RMSEA = 0.101, CFI = 0.959, GFI = 0.959; model fit for informational justice perceptions RMSEA = 0.136, CFI = 0.937, GFI = 0.946).

CONCLUSIONS

Patients' perceptions of interactional and informational justice play an essential role in their adherence to professional advice, their loyalty to the service, and their ability to develop trust and satisfaction in health services. Communication and relationship-building in patient-centered care should incorporate fairness considerations to enhance healthcare outcomes. Policies and programs should integrate these justice perceptions into patient-centered care strategies. We outline specific implications for improving healthcare quality and patient-centered care.

Clinical decision-making process and distributive justice: The mediating role of economic analysis. Empirical evidence from Italy

BACKGROUND

The COVID-19 pandemic has not only tested the resilience of public health systems but also underscored the criticality of allocative choices on health resources. These choices, however, are not confined to health emergencies but are integral to public health decisions, which inherently grapple with limited resources. In this context, physicians play a pivotal role as the architects of clinical actions in various scenarios. Therefore, doctors are called upon to make their decisions by considering not only the criteria of clinical appropriateness but also the ethical aspects linked, in particular, to the principle of justice. Indeed, the assessment of the effectiveness of a treatment for a particular patient must be balanced against criteria of equity and justice for the whole. To be fully applied, the principle of justice presupposes the use of economic evaluation techniques designed to drive the organisation decisions by effectiveness and efficiency.

METHODS

The present paper aims to empirically analyse whether and to what extent economic evaluation is known and used by doctors in healthcare decision-making and, therefore, what the most widespread approaches are used in such processes. In particular, this paper intends to present the results of an empirical study on a sample of doctors registered with the Order of Physicians in Lombardy (Italy), one of the areas most affected by the COVID-19 pandemic.

RESULTS

The research reveals a particular awareness of the criticality of allocation issues accompanied by a lack of knowledge of the economic evaluation techniques or, more broadly, by an almost total disuse of financial criteria. The main reasons are doctors' need for more knowledge of these tools and insufficient availability of economic information at the country system level.

CONCLUSION

In the conclusion, we propose some suggestions to facilitate the transition to more current decision-making models consistent with the characteristics of more advanced national healthcare contexts.

Advances in Technology Promote Patient-Centered Care in Cardiac Rehabilitation

Patient-centered health care (PCC) is a framework of clinical care focused on the patient's individual health care needs. In particular, it emphasizes the development of a partnership between the patient, physician, and healthcare workers to actively involve and empower the patient in their health care decisions. Additionally, PCC goals include ensuring access to care, emotional support, engaging patient support systems, physical comfort, and continuity of care. Technology also provides a platform to engage patients and their families in their care and can be a useful tool to gauge their level of interest, knowledge, and motivations to adequately educate them on the many factors that contribute to their disease, including diet, exercise, medication adherence, psychological support, and early symptom detection. In this article, we summarize the importance of technology in promoting PCC in cardiac rehabilitation and the impact technology may have on the different aspects of patient and physician relationships. Modern technological devices including smartphones, tablets, wearables, and other internet-enabled devices have been shown to help patient-staff communication, cater to patients' individual needs, increase access to health care, and implement aspects of PCC domains.

Physical therapist characteristics and therapeutic relationship process construct factors that improve patient health outcomes in physical therapy: a systematic review

BACKGROUND

It appears that the therapeutic relationship in physiotherapy practice facilitates the success of patient health outcomes, although the process by which it is carried out has been poorly studied.

OBJECTIVE

To explore the influence of the therapeutic relationship on any patient health outcomes in physical therapy settings.

METHODS

PubMed, Web of Science, Scopus, CINAHL, LILACS and Dialnet databases were systematically searched following PRISMA guidelines. The searches were completed in August 2024. Qualitative and quantitative studies measuring the therapeutic relationship and assessing its influence on health outcomes of patients treated with physical therapy were included.

RESULTS

The search yielded a total of 769 results. 13 studies ultimately retained for analysis. A total of 1555 individuals were studied who had suffered injuries such as low back pain; osteoarthritis; underwent cardiac surgery; hip fracture and elite athletes recovering from injuries. The results obtained were classified into three main themes: characteristics and skills of physical therapists (interpersonal, organizational, leadership and communication skills), therapeutic relationship factors (shared decision making, trusting relationships, motivating the patient and individualization of care) and patient health outcomes influenced by therapeutic relationship (functional outcomes, disability, pain intensity, outcome expectations, perceived global effect, adherence, self-efficacy, sports performance and lung function).

CONCLUSIONS

Through physical therapist's soft skills, therapeutic relationship factors are built under the paradigm of person-centered care and shared decision making, having a positive influence on certain patient health outcomes. Therefore, evidence support that therapeutic relationship contributes to improved patient health outcomes.

Exploring Preferences for Communication and Care among Hospitalized Patients with Opioid Use Disorder: A Qualitative Descriptive Study

OBJECTIVE

The aim of the study was to explore hospitalized patient priorities for effective communication and care in opioid use disorder (OUD).

METHODS

In this qualitative descriptive study, we conducted semistructured interviews from April to August 2022 focusing on communication values with inpatient care teams among hospitalized patients with OUD in Philadelphia, PA. Interviews were recorded, transcribed, and analyzed with thematic content analysis.

RESULTS

We identified 3 key themes in the communication and care planning preferences of the 21 patients we interviewed: effectiveness, reciprocity, and empathy. Patients emphasized the need for clear, reliable, and frequent communication from healthcare providers, valuing collaborative dialog, shared decision making, and empathic nonstigmatized interactions that incorporated their prior experiences, full personhood, and current symptoms. Participants reported negative experiences with inconsistent or dismissive communication but appreciated care that incorporated their input and was nonjudgmental, fostering a sense of trust in their healthcare teams.

CONCLUSIONS

Effective, empathic communication, and shared decision making were favored by hospitalized patients with OUD and may be a way to improve treatment for hospitalized patients with OUD. Our findings underscore the need for stigma reduction strategies in clinical education and the expansion of both generalist resources for the treatment of OUD and specialized addiction care services.

Developing a Quality Improvement Framework to Enhance the Health System User Experience for Individuals Living With Type 1 Diabetes: The Reshape T1D Study

INTRODUCTION

User experience design aims to create products and services that are accessible, usable, and enjoyable. The Reshape T1D study aims to apply these principles to understand how individuals living with T1D interact with and experience healthcare to inform T1D clinical quality improvement.

METHODS

Using a community-based participatory research design, we involved four patients and four clinicians as co-researchers throughout the research. A questionnaire and virtual semi-structured interview were applied across a purposeful sample of 41 adults living with T1D across Alberta, Canada, between September 2021 and May 2022. Audio recordings were transcribed verbatim and de-identified before coding. Thematic analysis was conducted on coded participant discourse through multiple coders.

RESULTS

Participants indicated the need for a centralized hub that provides consistent, reliable, and up-to-date T1D education and resources and an emphasis on access to mental health resources within T1D care settings. Providing greater flexibility for appointment types (ie. in-person, virtual, etc.) and after-hours access contributed to better self-management and prevented emergency room visits. Participants desired a choice as to who comprises their T1D care team and for teams to address patient needs specific to their reality. We identified that medical trauma had long-term impacts on perceptions of healthcare and contributed to a reluctance to seek future care. Women expressed challenges in discussing reproductive health with their clinicians. Diabetes online communities provide an adjunct to clinical care through peer support. Cost and access to the latest technology are ongoing barriers for many participants, especially concerning publicly funded programmes that use advanced insulin pump therapy, continuous glucose monitoring, and automated insulin delivery systems. A quality improvement framework emerged through data analysis, and findings were synthesized into actionable recommendations for ongoing clinical quality improvement.

CONCLUSION

Our findings highlight how important health system user suggestions are for more equitable, accessible, and empathetic healthcare for individuals living with T1D. Further work is needed to explore health system user experiences with clinicians and healthcare administrators to effectively carry out T1D clinical quality improvement.

Discerning Deinfibulation: Impact of Personal, Professional, and Familial Influences on Decision-Making

The past decades have seen large numbers of Somali women migrate across the globe. It is critical for healthcare workers in host countries to understand healthcare needs of Somali women. The majority of Somali female migrants experience female genital cutting (FGC). The most common type in Somalia is Type 3 or infibulation, the narrowing of the vaginal introitus. Deinfibulation opens the introitus to reduce poor health outcomes and/or allow for vaginal births. In this study, we explored the perspectives of Somali women living in the United States about deinfibulation. We recruited 75 Somali women who had experienced FGC through community-based participatory research methods. Bilingual community researchers conducted qualitative interviews in Somali or English. University faculty and community-based researchers coded data together in a participatory-analysis process. We identified four themes. (1) Personal Views: participants reported positive attitudes toward deinfibulation and varied on the appropriateness of deinfibulation before marriage. (2) Benefits: identified benefits included alleviation of health problems; improved sexual health, in particular reduction or prevention of sexual pain; and reclamation of body and womanhood. (3) Barriers: these included associated stigma and lack of knowledge by providers. (4) Decision-Making: most reported that husbands, healthcare providers, and elder female community members may provide advice about if and/or when to seek deinfibulation, though some felt deinfibulation decisions are solely up to the impacted woman. An ecological framework is used to frame the findings and identify the importance of healthcare workers in assisting women who have been infibulated make decisions.

Patient-physician agreement on function and pain is associated with long-term outcomes in sarcoma: findings from a longitudinal study

PURPOSE

We aimed to describe the level of agreement between patients and physicians on the ratings of daily functioning and pain in a cohort of sarcoma patients and assess how (dis)agreement and its change over time predicted patient-reported outcomes in survivorship.

METHOD

We performed secondary analysis of longitudinal data from a sarcoma-specialty clinic in Montreal, Canada. Demographics, clinical characteristics and patient-physician agreement were summarized descriptively. Linear mixed models were used to assess the effects of time, baseline agreement, change in agreement over time, interaction of time and change in agreement and 12-month daily functioning, quality of life, and fatigue.

RESULTS

Data were available for 806 patients (57.7% male, x̄ = 53.3 years) who completed at least one questionnaire. Patient-physician disagreement was common on the level of function (43.4%) and pain (45.7%). Baseline physician-patient agreement was associated with better 12-month outcomes. Improvement in agreement on function over time was significantly associated with daily functioning (F(2, 212) = 3.18, p = 0.043) and quality of life (F(2, 212) = 3.17, p < 0.044). The pattern was similar though less pronounced for the agreement on pain.

CONCLUSIONS

Our study offers novel insights into the importance of patient-physician agreement and communication's role in long-term patient-reported outcomes in sarcoma.

IMPLICATIONS FOR CANCER SURVIVORS

The results emphasize the importance of mutual understanding of symptoms and patients' needs and suggest that further consultation in cases of discordance of ratings and opinions might be beneficial for optimal survivorship.

Child-physician rapport at a neurodevelopmental clinic: In the eyes of the beholder

BACKGROUND

Building rapport with young patients is crucial for fostering a sense of comfort that enhances their cooperation during clinical encounters and improves clinical outcomes. The available data on children with neurodevelopmental disabilities in community-based settings, including data on child-physician rapport, is limited.

AIMS

To examine how children with neurodevelopmental disabilities perceive rapport with treating physicians compared to parents and treating physicians and to evaluate the relationship between the child-reported rapport and its impact on their cooperation.

METHODS

One hundred two children with neurodevelopmental disabilities (M years = 9.63, SD = 2.42) completed the CHARM-C Questionnaire, which assessed their experience of rapport with their examining physicians following neurodevelopmental assessments. In parallel, their parents and physicians completed the CHARM-A Questionnaire, which assessed how they perceived the children's experience of rapport (a total of 306 questionnaires). The physicians also rated children's cooperation. The data were analyzed using correlation, regression, and mixed linear analyses.

RESULTS

Children's perceptions of rapport were significantly less positive than those of parents (d = -0.60) and physicians (d = -0.45). A moderate partial correlation (r = .37) was found between children's and parents' perceptions. Neither children's nor parents' perceptions were correlated with physicians' perceptions. Children's perceptions of rapport were positively associated with greater cooperation (β = .28).

DISCUSSION

Children with neurodevelopmental disabilities rated their rapport with physicians lower than parents and doctors. Their evaluations offer valuable insights, complementing caregivers' and professionals' perspectives. Training physicians to improve their assessments of children's needs during medical encounters is critically important.

Strategies to Improve Equitable Access to Early Osteoarthritis Diagnosis and Management: An Updated Review

Though osteoarthritis (OA) affects millions of people worldwide, many fail to access recommended early, person-centered OA care, particularly women who are disproportionately impacted by OA. A prior review identified few strategies to improve equitable access to early diagnosis and management for multiple disadvantaged groups. We aimed to update that review with literature published in 2010 or later on strategies to improve OA care for disadvantaged groups including women. We identified only 11 eligible studies, of which only 2 (18%) focused on women only. Other disadvantaged groups targeted in the largely US-based studies included patients who are Black, Spanish-speaking, rural, and adults aged 60 years and older. All studies evaluated interventions targeted to patients; 4 (36%) assessed video decision aids, and 7 (63.6%) assessed in-person, video, or telephone self-management education. Interventions were often multifaceted (n = 9, 82%), and most studies (n = 8, 73%) achieved positive outcomes in at least some outcomes measured. No studies evaluated clinician- or system-level strategies. Few studies (n = 5, 45%) described how they tailored strategies to disadvantaged groups or how they addressed person-centered care concepts apart from enabling self-management. Future research is needed to develop, implement, evaluate, and scale-up multilevel strategies to enhance equitable, person-centered OA care for disadvantaged groups including women.

Knowledge, attitudes and preferences of parents/guardians regarding dental treatment of their children's primary teeth: a questionnaire cross-sectional study

PURPOSE

Assess the knowledge and attitudes of parents/guardians regarding their children's oral health and their preferences regarding the treatment of carious primary teeth.

METHODS

A cross-sectional study including the completion of a questionnaire by parents/guardians of healthy children aged 2-12 years attending the Department of Pediatric Dentistry (NKUA). Data were collected through 35 questions regarding demographic characteristics of the participants, oral hygiene and dietary habits, and parents' knowledge of the importance of oral health and primary teeth. Treatment preferences were assessed through clinical scenarios accompanied by colored clinical photographs. Results were presented in frequency tables and comparisons with specific child and parent-characteristics were evaluated using chi-squared and Fisher's exact test.

RESULTS

Parents were mainly females (73%), married (81%), aged > 40 years (56%), and high school graduates (57%). Most children brushed alone (56%), twice (48%) daily, with a manual toothbrush (65%) and consumed sugary snacks daily (38%). More than two-thirds of parents recognized the relationship between oral hygiene and general health (82%) and the importance of primary teeth (72%). Almost all parents would like to restore their children's asymptomatic (94%) and symptomatic (98%) primary teeth, with pulp therapy and stainless-steel crowns being the treatment of choice (58%). The decision on treatment about cavitated/non-cavitated primary teeth was not correlated with any of the parental or child-related factors. Acceptance of minimally invasive treatments was higher among highly educated parents and parents of boys.

CONCLUSION

Insight into parents' perceptions and preferences regarding the treatment of primary teeth is necessary and should be considered during treatment planning.

Mapping provider and consumer voices using the AACTT framework: a focus group study of advance care planning

BACKGROUND

The provision of healthcare is complex. When evidence-practice gaps are identified, interventions to improve practice across multi-level systems are required. These interventions often consist of multiple interacting components and behaviours. To effectively address these complexities, it is crucial to first identify the specific roles and actions required at each stage of the intervention. This approach enables a thorough examination of what is working well and what needs to be optimised. The action, actor, context, target, time (AACTT) framework provides a consistent approach to identifying key elements such as 'who' (actor) does 'what' (action), 'where' (context), 'to or with whom' (target) and 'when' (time). To our knowledge the AACTT has not yet been applied: 1) to specify complex interventions across patient journeys; and 2) to investigate consumer views, despite the importance of patient-centred care.

AIM

Using advance care planning (ACP) as an exemplar complex healthcare process, we describe a method for using the AACTT framework to 1) map a complex model of care across a patient journey 2) capture the consumer perspective; and 3) operationalise these perspectives by comparing across groups and identifying alignments or misalignments.

METHODS

Two groups were recruited (healthcare professionals and consumers). Informed by the AACTT framework, four focus groups discussed the process of ACP across existing care pathways. Maps visually representing the perspectives and preferences of healthcare professionals and consumers were co-created iteratively. Qualitative data was deductively coded to the AACTT framework and inductively coded to identify themes within domains. Maps were circulated for critical feedback and refined.

RESULTS

Healthcare professional (n-13) and consumer perspectives (n = 11) highlighted what is 'currently occurring' in practice, what is 'not occurring', and what 'should be occurring' to align practice with consumer preferences of care. Comparing participant perspectives identified that most misalignment occurred within the actor, context, and time domains. Misalignment was found predominantly in actions 'occurring sometimes', with no converging perspectives reported for the context and time domains.

CONCLUSION

This novel application of the AACTT framework systematically brings in the consumer voice in ways that may influence the delivery of care. This approach to specifying healthcare professional and consumer perspectives across a complex care pathway identifies barriers that are not found with traditional mapping methods or in current applications of the AACTT framework.

Preferred labels and language to improve communication about lesions at low risk of progressing to cancer: qualitative interviews with patients and physicians

OBJECTIVES

We explored how to improve communication about low-risk lesions including labels, language and other strategies.

DESIGN

Qualitative description and thematic analysis to examine the transcripts of telephone interviews with patients who had low-risk lesions and physicians; and mapping to Communication Accommodation Theory to interpret themes.

SETTING

Canada PARTICIPANTS: 15 patients: 6 (40%) bladder, 5 (33%) prostate and 4 (27%) cervix lesions; and 13 physicians: 7 (54%) cervix, 3 (23%) bladder and 3 (23%) prostate lesions.

MAIN OUTCOME MEASURES

Patient and physician views of labels, language and other strategies to improve communication about low-risk lesions.

RESULTS

Patients and clinicians held discordant views about low-risk lesion label impact, preferences and rationale. All labels prompted confusion and anxiety among patients. In contrast, physicians perceived that patients understood that labels they used across all label categories (abnormal, precursor-to-cancer and cancer) implied low risk for cancer progression. Patients preferred abnormal cells, particularly when first learning of their diagnosis, and desired additional information to distinguish their diagnosis from cancer and justify treatment. In contrast, physicians favoured precursor-to-cancer and cancer labels out of habit, to match labels that patients saw elsewhere (online, charts) and to convince patients to attend follow-up and treatment visits. However, patients and physicians largely agreed on the need for 16 strategies that could improve communication about low-risk lesions including language (eg, plain language, situate low-risk lesions on cancer spectrum) and complementary communication strategies (eg, longer appointments, visual aids, connect patients with support services or groups).

CONCLUSIONS

The findings build on prior research by revealing that modifying labels is not the only or best strategy needed to improve communication about low-risk lesions. Ongoing research should examine how best to implement the strategies recommended by patients and physicians.

The trends of patient engagement in a co-production healthcare services: a insights from a bibliometric analysis

PURPOSE

Co-production improves the quality of healthcare services by prioritizing patient-centred care and ensuring optimal implementation. Current patient participation research have primarily concentrated on the co-production stages, despite patient participation being the central emphasis of its implementation. A study conducted analysed four specific attributes of patient participation, with patient engagement specifically emphasizing the interactions between patients and healthcare workers. Several studies have concluded that the interaction between the two actors is inefficient. This article examines current study trends concerning patient participation and identifies knowledge gaps from these studies.

DESIGN/METHODOLOGY/APPROACH

This study used bibliometric analysis. This study used VOSviewer software for bibliometric analysis. The Scopus database contained 398 publications about patient participation in co-production in healthcare, which served as the basis for the analysis.

FINDINGS

The study on patient engagement in a co-production context for healthcare had grown fast in recent years. Patient-centred approach and patient-centred care were two important things in patient engagement. Several factors influenced the implementation of patient engagement: attitude, ability, awareness, responsibility and knowledge. It is still uncommon to do research on the measurement of output and results from patient engagement implementation. Studies on instruments for measuring these two factors, particularly in a quantitative manner, are still few.

RESEARCH LIMITATIONS/IMPLICATIONS

Various recommendations have been put forward for additional investigation. Firstly, further examination of outcome measurement in patient engagement is necessary, given the lack of decisive instruments available. Secondly, examining the most influential factors on patient engagement in co-production in healthcare. Thirdly, a more thorough analysis is needed regarding the dimensions of co-production, considering that some dimensions overlap, such as the activation and empowerment dimensions, which are really carried out during engagement. The researcher acknowledges the inherent limitations of bibliometric studies, including the dependence on the Scopus databases for extracting data and the choice of search phrases. Furthermore, conducting a systematic literature review may be necessary to thoroughly examine and delineate the research topics, methodologies and outcomes of this study.

ORIGINALITY/VALUE

This study updates us on patient engagement study trends and establishes a framework for implementing patient engagement in healthcare services.

"You Have to Find a Way for This Child to Be at the Center": Pediatric Cardiologists' Views on Triadic Communication in Consultations on Congenital Heart Defects

Congenital heart defects (CHDs) are present at birth and require ongoing management of personal, family, and medical aspects of care, including communication between family and medical staff. Effective communication is considered one of the main objectives of patient-centered care. Communication in pediatric medicine is especially challenging because it includes children and their parent(s), and children's cognitive and communication skills are still developing. Based on the model of behavior in pediatric communication , this study focused on pediatric cardiologists' views of the roles of children, parents, and physicians in the triadic encounter and their experiences in communicating information on pediatric CHDs in medical encounters. Semi-structured interviews were conducted with 17 experienced pediatric cardiologists and cardiac surgeons (five women and 12 men) at three medical centers in Israel. The grounded theory approach was used to identify three main categories: (1) the positioning (centrality) of the child in the setting (ideal vs. actual situation), (2) addressing parents' emotional needs, and (3) the physician's role as mediator between parent(s) and child. In each category, three elements are discussed: The physician's agenda, obstacles and challenges, and the physician's practical methods. Physicians strongly support children's involvement in triadic encounters yet face challenges in effectively integrating them into the information exchange process during cardiology consultations. Struggling to balance the principles of patient- and family-centered care, and without clear guidelines, they rely on their personal beliefs and experiences to formulate communication strategies that address parents' and children's needs.

A 360° Approach to Personalize Lifestyle Treatment in Primary Care for People With Type 2 Diabetes: Feasibility Study

BACKGROUND

Given the multifactorial nature of type 2 diabetes (T2D), health care for this condition would benefit from a holistic approach and multidisciplinary consultation. To address this, we developed the web-based 360-degree (360°) diagnostic tool, which assesses 4 key domains: "body" (physical health parameters), "thinking and feeling" (eg, mental health and stress), "behavior" (lifestyle factors), and "environment" (eg, work and housing conditions).

OBJECTIVE

This work examines the acceptability, implementation, and potential effects of the 360° diagnostic tool and subsequent tailored treatment (360° approach) in a 6-month intervention and feasibility study conducted in standard primary health care settings in the Netherlands.

METHODS

A single-group design with baseline, 3-month, and 6-month follow-ups was used. A total of 15 people with T2D and their health care providers from 2 practices participated in a 6-month intervention, which included the 360° diagnosis, tailored treatment, and both individual and group consultations. The 360° diagnosis involved clinical measurements for the "body" domain and self-reports for the "thinking and feeling," "behavior," and "environment" domains. After multidisciplinary consultations involving the general practitioner, pharmacist, nurse practitioner (NP), and dietitian, the NP and dietitian provided tailored advice, lifestyle treatment, and ongoing support. At the end of the intervention, face-to-face semistructured interviews were conducted with health care professionals (n=6) and participants (n=13) to assess the acceptability and implementation of the 360° approach in primary health care. Additionally, data from 14 participants on the "thinking and feeling" and "behavior" domains at baseline, 3 months, and 6 months were analyzed to assess changes over time.

RESULTS

The semistructured interviews revealed that both participants with T2D and health care professionals were generally positive about various aspects of the 360° approach, including onboarding, data collection with the 360° diagnosis, consultations and advice from the NP and dietitian, the visual representation of parameters in the profile wheel, counseling during the intervention (including professional collaboration), and the group meetings. The interviews also identified factors that promoted or hindered the implementation of the 360° approach. Promoting factors included (1) the care, attention, support, and experience of professionals; (2) the multidisciplinary team; (3) social support; and (4) the experience of positive health effects. Hindering factors included (1) too much information, (2) survey-related issues, and (3) time-consuming counseling. In terms of effects over time, improvements were observed at 3 months in mental health, diabetes-related problems, and fast-food consumption. At 6 months, there was a reduction in perceived stress and fast-food consumption. Additionally, fruit intake decreased at both 3 and 6 months.

CONCLUSIONS

Our findings suggest that the 360° approach is acceptable to both people with T2D and health care professionals, implementable, and potentially effective in fostering positive health changes. Overall, it appears feasible to implement the 360° approach in standard primary health care.

TRIAL REGISTRATION

Netherlands Trial Register NL-7509/NL-OMON45788; https://onderzoekmetmensen.nl/nl/trial/45788.

Adherence to low back pain clinical guidelines in Australian hospital emergency departments: A public and private comparison

Managing LBP via clinical practice guidelines in healthcare settings is recommended, yet burgeoning evidence suggests adherence is suboptimal in emergency department settings. Whether adherence differs between public and private settings is unknown. A retrospective audit of two Australian emergency departments matched 86 private patients to 86 public patients by age ( ± 5 years), sex (male/female) and LBP duration (first time/history of LBP). Patient charts were reviewed according to the Australian clinical guidelines for the management of LBP. Guidelines were considered individually and via a collective guideline adherence score (GAS). Management GAS was lower in private patients compared to public patients (d [95 %CI]: -0.67 [-0.98, -0.36], P < 0.001). Public patients were more likely to have documentation of guideline-based advice (OR [95 %CI]: 4.4 [2.4, 8.4], P < 0.001) and less likely to be sent for imaging (OR [95 %CI]: 5.0 [2.6, 9.4], P < 0.001). Private patients were more likely to have documented screening for psychosocial risk factors (OR [95 %CI]: 21.8 [9.1, 52.1], P < 0.001) and more likely to receive guideline-based medication prescriptions at patient discharge (OR [95 %CI]: 2.2 [1.2, 4.2], P = 0.013). Differences exist in public and private hospital emergency department guideline adherence. Exploring barriers and facilitators underpinning these differences will assist in guiding future implementation science approaches.

Public involvement and public engagement: An example of convergent evolution? Findings from a conceptual qualitative review of patient and public involvement, and public engagement, in health and scientific research

Objective

Patient and public involvement (PPI) in health research is now well-established, whilst science, technology, engineering and mathematics (STEM) research has shifted from a focus on science communication alone to public engagement (PE) within its research processes. Despite frequently drawing on similar theoretical influences, and practical motivations, there is often a lack of dialogue between such settings meaning shared learning, practice and evidence from these two sectors are rarely pooled.

Methods

In this article, we examine findings from a conceptual review of literature gathered between 1996 and 2019.

Results

Analyzing 142 peer-reviewed articles, we ascertain shared definitions and concepts in patient and public involvement and public engagement, identifying key differences and similarities.

Conclusion

The literature we review supports the notion that, in terms of origins, there are two distinct traditions, one based in science communication and one based in what we describe as public involvement in shared decision-making.

Innovation

We find evidence that the two traditions are converging but our work also calls for the need for further conversations between these two settings, which are exploring intersecting issues but from parallel pathways.

Web-based interventions in the clinical encounter in fertility care: a scoping review

There has been a huge increase in the development of new e-health initiatives, including interventions supporting the interaction between patients and healthcare professionals - the clinical encounter. This interaction can influence clinical decision making during a patient's workup or treatment process. This scoping review was designed (i) to display the current landscape of web-based interventions to support the clinical encounter, and (ii) to critically appraise their composition. A literature search of different electronic databases was conducted. The study interventions were required to be for infertile patients and internet based, including the clinical encounter. The selected studies were systematically appraised. Twenty-eight studies were included and divided into four categories: online platform (10 studies), telemonitoring (3 studies), teleconsulting (8 studies) and artificial intelligence (7 studies). The online platform and teleconsulting categories focused most on patient-reported outcomes, with positive results. The other categories focused on development and validation. In conclusion, this review shows a broad landscape of web-based interventions in the clinical encounter, for healthcare professionals and fertility patients. The teleconsulting and the online platform categories have the most 'ready-to-use' interventions. However, the actual implementation of the interventions was evaluated in only four studies, suggesting challenges with implementation research and the need for standardized implementation protocols.

Lived experience of hypertensive disorders of pregnancy: a systematic review and meta-synthesis

BACKGROUND

Hypertensive disorders are major causes of maternal and neonatal morbidity and mortality, affecting ∼10% pregnancies worldwide.

OBJECTIVE

Understanding the lived experience of women with hypertensive disorders during pregnancy is important to inform best practice and provide holistic care.

STUDY DESIGN

This is a systematic review and meta-synthesis of studies containing qualitative components relating to direct lived experience of hypertensive disorders of pregnancy. Medline via Ovid, Embase via Ovid, CINAHL via Ebsco, PsycINFO via Ebsco, Scopus, Web of Science Core Collection, and ASSIA via ProQuest were searched between database inception and June 2024. Quality assessment was performed using the Critical Appraisal Skills Programme checklist for qualitative research. Themes were labeled and organized into a framework using NVivo software.

RESULTS

Eighteen studies were included in the meta-synthesis. Anxiety, stress, fear and panic emerged as the most common emotional experiences during hypertensive disorders of pregnancy. Loss of control was also mentioned frequently and consistently across studies (frequency effect size 38.9% and intensity effect size 15.3%). Emotional responses to physical symptoms or lack thereof, and feelings about the impact of the complicated pregnancy on family and community also emerged as central themes associated with hypertensive disorders of pregnancy.

CONCLUSION

A range of emotional experiences was captured across the studies included in our meta-synthesis, some of which were observed across global settings whereas others were context-dependent. Interventions and care pathways for pregnancies affected by hypertensive disorders should aim to support women through complex emotional experiences as well as reducing morbidity and mortality.

Psychometric evaluation of the Dutch version of the patient-reported experience measure for addiction treatment (PREMAT-NL)

INTRODUCTION

Patient-centred care has become increasingly important in health care. Patient-reported experience measures (PREM) are used to measure patient experiences in health care, but the availability of psychometrically validated PREMs is limited. The Patient Reported Experience Measure in Addiction Treatment (PREMAT) is a PREM developed with extensive service user input to assess the experiences of people in residential addiction treatment services. In this study we aimed to evaluate the psychometric properties of the Dutch translation of the PREMAT, the PREMAT-NL.

METHODS

Ninety-three participants completed the PREMAT-NL approximately 45 days after starting addiction treatment as part of a naturalistic prospective multi-centre study in Belgium. We examined the factorial structure using principal component analysis with Promax oblique rotation and assessed the internal consistencies of the subscales and total score using Cronbach's α. Additionally, we explored the relationship of PREMAT-NL scores with demographic and clinical variables.

RESULTS

The PREMAT-NL had a four-factor structure, with good internal consistencies of the subscales (Cronbach's α >0.70) and excellent internal consistency of the total score (Cronbach's α = 0.94). The PREMAT-NL total score was negatively skewed, and four score categories were proposed based on z-scores. PREMAT-NL scores correlated weakly with the type of treatment centre (r = 0.21, p < 0.05) and with previously received treatment for addiction (r = -0.25, p < 0.05).

DISCUSSION AND CONCLUSIONS

Although the factor structure and thus the appropriate use of subscales need further investigation, the findings of this study support the use of the PREMAT-NL total score as a valid and reliable PREM to evaluate residential addiction treatment services.

Patients' perception of the quality of psychiatric inpatient care in the Faroe Islands

PURPOSE

Evaluating the quality of psychiatric care from the patient's perspective is crucial to measure the effectiveness of the provided care. This study aimed to translate the original Swedish Quality in Psychiatric Care - Inpatient (QPC-IP) instrument into Faroese, adapting it to the specific context of psychiatric inpatient care in the Faroe Islands, conducting a detailed evaluation of its psychometric properties, and to describe patients' perception of quality of psychiatric care.

MATERIALS AND METHODS

Following a thorough translation and back-translation, the content validity of the Faroese QPC-IP was confirmed by a group of Faroese patients. Subsequently, the instrument was completed by 61 psychiatric inpatients.

RESULTS

Item total correlations revealed that most items strongly correlated with their intended dimensions, mirroring the original Swedish version. However, a noteworthy exception was found in the discharge dimension, leading to the exclusion of an item related to helping find an occupation; this task was not performed by the ward. While the internal consistency of the overall scale was excellent, specific dimensions exhibited lower consistency.

CONCLUSIONS

The translation and cultural adaptation of the Faroese QPC-IP proved satisfactory. The psychometric evaluation affirmed a shared understanding of the quality of psychiatric care in both Faroese and Swedish cultural contexts. As a result, the Faroese QPC-IP emerges as a valuable instrument for assessing the quality of psychiatric care in the Faroe Islands. Its utility extends to quality assurance initiatives and contributes to cross-cultural research examining the quality of psychiatric care from the patient's perspective.

The time for patient partnership in medical education has arrived: Critical reflection through autoethnography from a physician turned patient

PURPOSE

This paper explores experiences of a physician who in one life-altering day awoke in intensive care and had to embark on a complex journey as full-time patient. It identifies the important literature, albeit limited, from a unique dual lens view of physician turned patient, and analyzes the potential for advancing medical education by recognizing the expertise that patients possess from lived experience.

METHODOLOGY

An autoethnography study was undertaken to unpack data obtained from lived patient experience during a two-and-a-half-year long hospitalization. Themes were captured in a series of eleven scenarios. Findings included critical reflection from the patient, medical educator, and research perspectives. Data was cross-referenced with relevant literature.

RESULTS

Seven themes emerged upon critical analysis of the eleven scenarios that described real-life healthcare encounters of the physician turned patient. These often-neglected themes from medical education include experiential learning, reflection, what counts as medical care, vulnerability, patient-centred care, agency, and patient expertise.

CONCLUSIONS

This study highlights differences between intellectual-experiential knowledge, and challenges medical education to harness the expertise that patients possess. It contributes to scholarly discourses by demonstrating the utility of autoethnography in medical education, critiques traditional medical education models, expands the breadth of what constitutes knowledge, and invites medical educators to actively involve patients as equal stakeholders in curricula.

Predicting Postoperative Satisfaction with Breasts: How Important is the Preoperative BREAST-Q Score?

BACKGROUND

The role that preoperative Satisfaction with Breast plays in a patient's postoperative course after postmastectomy breast reconstruction (PMBR) is not understood. The aim of this study is to understand the impact of the preoperative score on postoperative outcome as an independent variable.

METHODS

We examined patients who underwent PMBR between 2017 and 2021 and who completed the BREAST-Q Satisfaction with Breasts at 1 year postoperatively. Two multiple linear regression models (Model 1 with the preoperative Satisfaction with Breasts score and Model 2 without the preoperative score), likelihood ratio tests, simple t-statistics, and sample patient dataset to predict the 1 year score were performed. Multiple imputation was used to account for missing preoperative scores.

RESULTS

Overall, 2324 patients were included. Model 1 showed that the preoperative score is significantly associated with the postoperative score (β = 0.09, 95% confidence interval 0.04-0.14; p < 0.001). Comparing Model 1 and Model 2 demonstrated that including preoperative Satisfaction with Breasts in a regression significantly improves model fit (test statistic = 10.04; p = 0.0021). Using the absolute value of the t-statistics as a measure of variable importance in linear regression, the importance of the preoperative score was quantified as 3.39-more important than neoadjuvant radiation, mastectomy weight, body mass index, bilateral prophylactic mastectomy, and race, but less than adjuvant radiation, reconstruction type, and psychiatric diagnoses.

CONCLUSION

Preoperative Satisfaction with Breasts scores are an important independent predictor of postoperative satisfaction after PMBR. Just as vital sign and work-up are carefully documented before surgery, preoperative scores should be collected to pre-emptively gauge patients' satisfaction and optimize postoperative outcomes.

Sleep Quality and Urinary Incontinence in Prostate Cancer Patients: A Data Analytics Approach with the ASCAPE Dataset

BACKGROUND

The ASCAPE project aims to improve the health-related quality of life of cancer patients using artificial intelligence (AI)-driven solutions. The current study employs a comprehensive dataset to evaluate sleep and urinary incontinence, thus enabling the development of personalized interventions.

METHODS

This study focuses on prostate cancer patients eligible for curative treatment with surgery. Forty-two participants were enrolled following their diagnosis and were followed up at baseline and 3, 6, 9, and 12 months after surgical treatment. The data collection process involved a combination of standardized questionnaires and wearable devices, providing a holistic view of patients' QoL and health outcomes. The dataset is systematically organized and stored in a centralized database, with advanced statistical and AI techniques being employed to reveal correlations, patterns, and predictive markers that can ultimately lead to implementing personalized intervention strategies, ultimately enhancing patient QoL outcomes.

RESULTS

The correlation analysis between sleep quality and urinary symptoms post-surgery revealed a moderate positive correlation between baseline insomnia and baseline urinary symptoms (r = 0.407, p = 0.011), a positive correlation between baseline insomnia and urinary symptoms at 3 months (r = 0.321, p = 0.049), and significant correlations between insomnia at 12 months and urinary symptoms at 3 months (r = 0.396, p = 0.014) and at 6 months (r = 0.384, p = 0.017). Furthermore, modeling the relationship between baseline insomnia and baseline urinary symptoms showed that baseline insomnia is significantly associated with baseline urinary symptoms (coef = 0.222, p = 0.036).

CONCLUSIONS

The investigation of sleep quality and urinary incontinence via data analysis through the ASCAPE project suggests that better sleep quality could improve urinary disorders.

Perceptions of Carriership of Extended-Spectrum Beta-Lactamase (ESBL)-Producing Bacteria: A Qualitative Study

The spread of antimicrobial resistance is a global health concern, and resistance mediated by Extended-Spectrum Beta-Lactamases (ESBLs) can cause major consequences. The aim of this study was to explore individuals' perceptions of their daily life and how they cope after being diagnosed with carriage of ESBL-producing bacteria. A qualitative study was conducted with a descriptive design. Data were collected through individual interviews with 24 persons having ESBL carriership, via a semi-structured interview guide. The data were analyzed using qualitative content analysis. The informants' perceptions on "Living with uncertainty about carriership that impacts oneself and others" were interpreted. Experiences of altered behaviors and sentiments due to ESBL carriership were described, as ESBL carriership was perceived to have a psychosocial impact on many informants. Ambiguous and inconsistent information tended to exacerbate these perceptions. The results of this study emphasize the importance of conveying individualized information, both at the time of diagnosis of ESBL carriage and thereafter. This study was not registered.

Are the content and usability of a new direct observation tool adequate for assessing competency in delivering person-centred care: a think-aloud study with patients and healthcare professionals in Sweden

OBJECTIVE

To evaluate the content and usability of a new direct observation tool for assessing competency in delivering person-centred care based on the Gothenburg Centre for Person-Centred Care (gPCC) framework.

DESIGN

This is a qualitative study using think-aloud techniques and retrospective probing interviews and analyzed using deductive content analysis.

SETTING

Sessions were conducted remotely via Zoom with participants in their homes or offices.

PARTICIPANTS

11 participants with lengthy experience of receiving, delivering and/or implementing gPCC were recruited using purposeful sampling and selected to represent a broad variety of stakeholders and potential end-users.

RESULTS

Participants generally considered the content of the four main domains of the tool, that is, person-centred care activities, clinician manner, clinician skills and person-centred care goals, to be comprehensive and relevant for assessing person-centred care in general and gPCC in particular. Some participants pointed to the need to expand person-centred care activities to better reflect the emphasis on eliciting patient resources/capabilities and psychosocial needs in the gPCC framework. Think-aloud analyses revealed some usability issues primarily regarding difficulties or uncertainties in understanding several words and in using the rating scale. Probing interviews indicated that these problems could be mitigated by improving written instructions regarding response options and by replacing some words. Participants generally were satisfied with the layout and structure of the tool, but some suggested enlarging font size and text spacing to improve readability.

CONCLUSION

The tool appears to satisfactorily cover major person-centred care activities outlined in the gPCC framework. The inclusion of content concerning clinician manner and skills was seen as a relevant embellishment of the framework and as contributing to a more comprehensive assessment of clinician performance in the delivery of person-centred care. A revised version addressing observed content and usability issues will be tested for inter-rater and intra-rater reliability and for feasibility of use in healthcare education and quality improvement efforts.

Designing a Workplace-Based Learning Environment for Learning Health Promotion: A Design-Based Research

Introduction

The healthcare landscape has a growing emphasis on health promotion (HP), which makes HP important in the training of future physicians. This study employed design-based research to develop a clerkship focused on HP and to outline design principles for shaping workplace learning environments to promote HP learning.

Methods

We evaluated a nursing-home clerkship designed at Radboud University Medical Center in the Netherlands, and refined it over three rounds. Data collection involved individual and group interviews with students and supervisors, as well as observations during clerkship-related meetings and activities. These interactions also facilitated the exchange of perspectives between participants and generation of new design ideas, fostering co-creation of the clerkship design. Data were analyzed through iterative thematic inquiry to inform new design choices and develop design principles.

Results

Evolved clerkship designs included an app for capturing practice experiences to discuss in relation to students' professional roles, loosening the strict assessment structure, and collaborative creation of a practice assignment about 'Positive Health'. We constructed four design principles, including: to question and discuss students' professional identity, provide concrete and meaningful assignments, aim for a peer-learner role for supervisors, and foster co-creation of the workplace learning environment.

Discussion

Our design principles support the design of workplace-based learning for HP, a subject that is novel within healthcare practice. We find that co-creation of workplace-based learning, which requires embracing uncertainty, is pivotal in this context, for students, practitioners, and educational institutions.

What to take up from the patient's talk? The clinician's responses to the patient's self-disclosure of their subjective experience in the psychiatric intake interview

During psychiatric diagnostic interviews, the clinician's question usually targets specific symptom descriptions based on diagnostic categories for ICD-10/DSM-5 (2, 3). While some patients merely answer questions, others go beyond to describe their subjective experiences in a manner that highlights the intensity and urgency of those experiences. By adopting conversation analysis as a method, this study examines diagnostic interviews conducted in an outpatient clinic in South Finland and identifies sequences that divulge patients' subjective experiences. From 10 audio-recorded diagnostic interviews, 40 segments were selected where patients replied to medically or factually oriented questions with their self-disclosures. The research focus was on the clinicians' responses to these disclosures. We present five sequential trajectories that the clinicians offered third-position utterances in response to their patients' self-disclosure of subjective experiences. These trajectories include the following: 1) the clinician transfers the topic to a new agenda question concerning a medical or factual theme; 2) the clinician presents a follow-up question that selects a topic from the patient's self-disclosure of a subjective experience that may orient either towards the medical/factual side or the experiential side of the patient's telling; 3) the clinician provides an expert interpretation of the patient's self-disclosure of his or her subjective experience from the clinician's expert perspective; 4) the clinician gives advice that orients mainly to a treatment recommendation or to another activity; and 5) the clinician presents a formulation that focusses on the core of their patient's self-disclosure of his or her subjective experience from the patient's perspective. In addition, we present what these responsive practices invoke from the patient in the next turn. We argue that an awareness of these strategies facilitates both the diagnosis and an appropriate therapeutic relationship during the psychiatric assessment interview. Finally, we discuss the clinical significance of our results regarding the patient's agency and the clinician's more conscious patient-centred orientation in the psychiatric assessment procedure.

Patient-centered outcomes and outcome measurements for people aged 65 years and older-a scoping review

INTRODUCTION

The aging population is a challenge for the healthcare system that must identify strategies that meet their needs. Practicing patient-centered care has been shown beneficial for this patient-group. The effect of patient-centered care is called patient-centered outcomes and can be appraised using outcomes measurements.

OBJECTIVES

The main aim was to review and map existing knowledge related to patient-centered outcomes and patient-centered outcomes measurements for older people, as well as identify key-concepts and knowledge-gaps. The research questions were: How can patient-centered outcomes for older people be measured, and which patient-centered outcomes matters the most for the older people?

STUDY DESIGN

Scoping review.

METHODS

Search for relevant publications in electronical databases, grey literature databases and websites from year 2000 to 2021. Two reviewers independently screened titles and abstracts, followed by full text review and extraction of data using a data extraction framework.

RESULTS

Eighteen studies were included, of which six with involvement of patients and/or experts in the process on determine the outcomes. Outcomes that matter the most to older people was interpreted as: access to- and experience of care, autonomy and control, cognition, daily living, emotional health, falls, general health, medications, overall survival, pain, participation in decision making, physical function, physical health, place of death, social role function, symptom burden, and time spent in hospital. The most frequently mentioned/used outcomes measurements tools were the Adult Social Care Outcomes Toolkit (ASCOT), EQ-5D, Gait Speed, Katz- ADL index, Patient Health Questionnaire (PHQ9), SF/RAND-36 and 4-Item Screening Zarit Burden Interview.

CONCLUSIONS

Few studies have investigated the older people's opinion of what matters the most to them, which forms a knowledge-gap in the field. Future research should focus on providing older people a stronger voice in what they think matters the most to them.

What do parents want from healthcare services? Reports of parents' experiences with pediatric service delivery for their children with disabilities

PURPOSE

Family-centred service (FCS) is an established approach for delivering services in children's rehabilitation and healthcare. This article describes that parents continue to report mixed experiences with healthcare services for their children, as well as their ideas about what they need and want from these services. These findings will inform the development of an up-to-date measure of Family-Centred Service called Measure of Processes of Care (MPOC 2.0).

METHODS

A qualitative descriptive study was conducted with parents, using focus groups and open-ended interviews. Data were analyzed using inductive content analysis.

RESULTS

Parents want care that is individualized, co-ordinated, easily accessible, and takes into account the entire family dynamic. They want service providers (SPs) to be informed and invested in their child's care, and to provide parents with practical assistance. They also want to be treated with respect, caring and empathy, and to work together with SPs on the care plan. Novel components of care not identified in the original FCS guiding principles include: responsiveness to needs and mental health; effective communication (vs information giving); practical support (in addition to emotional and informational support); and availability and scheduling.

CONCLUSIONS

This article identifies components of healthcare that families find helpful and desirable.

Analysis and mapping the research landscape on patient-centred care in the context of chronic disease management

RATIONALE

Patient-centred care has emerged as a transformative approach in managing chronic diseases, aiming to actively involve patients in their healthcare decisions.

AIMS AND OBJECTIVES

This study was conducted to analyse and map the research landscape on patient-centred care in the context of chronic disease management.

METHODS

This study used Scopus to retrieve the relevant articles. The analysis focused on the growth pattern, highly cited articles, randomised clinical trials, patients and providers perspectives, facilitators and barriers, frequent author keywords, emerging topics, and prolific countries and journals in the field.

RESULTS

In total, 926 research articles met the inclusion criteria. There was a notable increase in the number of publications over time. Cancer had the highest number of articles (n = 379, 40.9%), followed by diabetes mellitus, and mental health and psychiatric conditions. Studies on patient-centred care in diabetic patients received the highest number of citations. The results identified 52 randomised controlled trials that covered four major themes: patient-centred care for diabetes management, shared decision-making in mental health and primary care, shared decision-making in cancer care, and economic evaluation and cost-effectiveness. The study identified 51 studies that examined the impact of tools such as computer-based systems, decision aids, smartphone apps, and online tools to improve patient-centred outcomes. A map of author keywords showed that renal dialysis, HIV, and atrial fibrillation were the most recent topics in the field. Researchers from the United States contributed to more than half of the retrieved publications. The top active journals included "Patient Education and Counselling" and "Health Expectations".

CONCLUSION

This study provides valuable insights into the research landscape of patient-centred care within the context of chronic diseases. The current study provided a comprehensive overview of the research landscape on patient-centred care, which can empower patients by raising their awareness about clinical experiences and outcomes.

Exploring the Inclusion of Person-Centered Care Domains in Stroke Transitions of Care Interventions: A Scientific Statement From the American Heart Association

BACKGROUND

Health care teams along the stroke recovery continuum have a responsibility to support care transitions and return to the community. Ideally, individualized care will consider patient and family preferences, best available evidence, and health care professional input. Person-centered care can improve patient-practitioner interactions through shared decision-making in which health professionals and institutions are sensitive to those for whom they provide care. However, it is unclear how the concepts of person-centered care have been described in reports of stroke transitional care interventions.

METHODS

A secondary analysis of a systematic review and meta-analysis was undertaken. We retrieved all included articles (n=17) and evaluated the extent to which each intervention explicitly addressed 7 domains of person-centered care: alignment of care with patients' values, preferences, and needs; coordination of care; information and education; physical comfort; emotional support; family and friend involvement; and smooth transition and continuity of care.

RESULTS

Most of the articles included some aspects of person-centeredness; we found that certain domains were not addressed in the descriptions of transitional care interventions, and no articles mentioned all 7 domains of person-centered care. We identified 3 implications for practice and research: (1) delineating person-centered care components when reporting interventions, (2) elucidating social and cultural factors relevant to the study sample and intervention, and (3) clearly describing the role of family and nonmedical support in the intervention.

CONCLUSIONS

There is still room for greater consistency in the reporting of person-centeredness in stroke transitions of care interventions, despite a long-standing definition and conceptualization of person-centered care in academic and clinically focused literature.

Relationship Between Physical Exercise and Cognitive Function Among Older Adults in China: Cross-Sectional Population-Based Study

BACKGROUND

The existing literature reveals several significant knowledge gaps that hinder health care providers in formulating exercise prescriptions for cognitive health.

OBJECTIVE

This study endeavors to elucidate the relationship between the level of physical activity and cognitive function in older adults in China. Moreover, it seeks to explore the associations between distinct exercise behaviors-such as exercise types, the purpose motivating engagement in exercise, the accessibility of exercise fields, and the inclination toward exercise-and cognitive function.

METHODS

Using data from the China Longitudinal Aging Social Survey (CLASS conducted in 2016, cognitive function was meticulously assessed through the modified Chinese version of the Mini-Mental State Examination, encompassing measures of orientation, memory, and calculation. Using self-report structured questionnaires, a myriad of information about physical activity during leisure time, exercise engagement, exercise intensity, primary exercise types, reasons for exercise participation, availability of sports facilities, and exercise willingness was diligently gathered. Robust ordinary least squares regression models were then used to compute coefficients along with 95% CIs.

RESULTS

A discernible inverted U-shaped trend in cognitive scores emerged as the level of physical activity surpassed the threshold of 500 metabolic equivalents of task (MET) minutes per week. Notably, individuals with a physical activity level between 500 and 999 MET minutes per week exhibited a coefficient of 0.31 (95% CI 0.09 to 0.54), those with a physical activity level between 1000 and 1499 MET minutes per week displayed a coefficient of 0.75 (95% CI 0.52 to 0.97), and those with a physical activity level above 1500 MET minutes per week demonstrated a coefficient of 0.45 (95% CI 0.23 to 0.68). Older individuals engaging in exercise at specific MET levels showcased superior cognitive function compared to their inactive counterparts. Furthermore, individuals driven by exercise motivations aimed at enhancing physical fitness and health, as well as those using sports facilities or public spaces for exercise, exhibited notably higher cognitive function scores.

CONCLUSIONS

The findings underscore the potential of exercise as a targeted intervention for the prevention and treatment of dementia or cognitive decline associated with aging in older individuals. Leveraging these insights to formulate informed exercise recommendations holds promise in addressing a significant public health challenge linked to aging populations.

Feasibility Study of Using the Integrated Telemedicine Platform “IS-cardio” for Outpatient Cardiological Rehabilitation: Single-Centered Cohort Study

INTRODUCTION. The implementation of remote cardiac rehabilitation (RCR) technology based on telemedicine platforms (TMP) requires a preliminary assessment of the feasibility of use. AIM. A preliminary study of the feasibility of using the integrated TMP “IS-cardio” to perform RCR in patients with cardiovascular diseases (CVD) in the context of need, feasibility and acceptability. MATERIALS AND METHODS. Single-center cohort study of patients (n = 33; 75 % men; mean age 56 ± 8 years) with CVD. Testing of the TMP «IS-cardio» was carried out during 12-week physical training (PT) programs with an intensity of 55 %. Feasibility was assessed according to the following criteria: need, feasibility, acceptability. Data on need and acceptability were obtained from a patient survey. Feasibility was assessed as the proportion of patients completing RCR. Remote monitoring was performed using heart rate, blood pressure, electrocardiogram and mobile application recorders. Feedback was provided in the form of electronic reports and delayed consultation. Patient satisfaction was assessed in points. RESULTS. 79.2 % of respondents were interested in telemedicine monitoring. 100 % of patients completed RCR; 12 patients (39.6 %) fully completed the PT program. The patients’ activity amounted to 2.4 ± 0.7 PT sessions per week; the average duration of PT was 56.5 ± 29.8 min/week. With a total satisfaction of 29.0 ± 3 points, the level of RCR was highly rated (3.85 ± 0.16 points) as a real solution to the problem associated with the presence of CVD (3.67 ± 0.34 points). DISCUSSION. The medical-technological solution TMP “IS-cardio”, combining the principles of traditional cardiac rehabilitation with telecardiology tools (monitoring based on digital recorders, automatic data transfer and feedback) met the criteria for the feasibility of using TMP with a similar concept. CONCLUSION. The high demand for remote monitoring, feasibility, and patient satisfaction of RCR may indicate the feasibility of its use for implementation of its programs.

Multi-Modal Prehabilitation in Thoracic Surgery: From Basic Concepts to Practical Modalities

Over the last two decades, the invasiveness of thoracic surgery has decreased along with technological advances and better diagnostic tools, whereas the patient's comorbidities and frailty patterns have increased, as well as the number of early cancer stages that could benefit from curative resection. Poor aerobic fitness, nutritional defects, sarcopenia and "toxic" behaviors such as sedentary behavior, smoking and alcohol consumption are modifiable risk factors for major postoperative complications. The process of enhancing patients' physiological reserve in anticipation for surgery is referred to as prehabilitation. Components of prehabilitation programs include optimization of medical treatment, prescription of structured exercise program, correction of nutritional deficits and patient's education to adopt healthier behaviors. All patients may benefit from prehabilitation, which is part of the enhanced recovery after surgery (ERAS) programs. Faster functional recovery is expected in low-risk patients, whereas better clinical outcome and shorter hospital stay have been demonstrated in higher risk and physically unfit patients.

What Patients Facing Cancer and Caregivers Want From Communication in Times of Crisis: A Qualitative Study in the Early Months of the COVID-19 Pandemic

BACKGROUND

Interpersonal communication is a cornerstone of patient-centered care. We aimed to identify what patients with cancer and caregivers may want from communication during a public health crisis.

METHODS

We interviewed 15 patients (8 Veteran, 7 non-Veteran) and caregivers from regionally, racially, and ethnically diverse backgrounds across the US about serious illness care and quality of care during the COVID-19 pandemic Using an iterative, inductive and deductive process, 2 coders analyzed content associated with the code "Communication," which appeared 71 times, and identified 5 themes.

RESULTS

Participants identified as White (10), Latino/a (3), Asian (1), and Black (1). (1) Help patients and caregivers prepare for care during crisis by communicating medical information directly and proactively. (2) Explain how a crisis might influence medical recommendations and impact on recovery from illness. (3) Use key messengers to improve communication between primary teams, patients, and caregivers. (4) Include caregivers and families in communication when they cannot be physically present. (5) Foster bidirectional communication with patients and families to engage them in shared decision-making during a vulnerable time.

CONCLUSION

Communication is critical during a public health crisis yet overwhelmed clinicians may not be able to communicate effectively. Communicating with caregivers and family, transparent and timely communication, ensuring diverse providers are on the same page, and effective listening are known gaps even before the COVID-19 pandemic. Clinicians may need quick interventions, like education about goals of care, to remind them about what seriously ill patients and their caregivers want from communication and offer patient-centered care during crises.

Application of Patient Sentiment Analysis to Evaluate Glaucoma Care

PURPOSE

Patients utilize online physician reviews to decide between and rate ophthalmologists. Sentiment analysis allows for better understanding of patient experiences. In this study, Valence Aware Dictionary sEntiment Reasoner (VADER) and word frequency analysis of glaucoma specialist Healthgrades reviews were used to determine factors prioritized by patients.

DESIGN

Retrospective cross-sectional analysis.

PARTICIPANTS

N/A.

METHODS

Written reviews and Star ratings of glaucoma specialists listed under the Physicians Payments Sunshine Acts were obtained, and demographic information was collected. Valence Aware Dictionary sEntiment Reasoner produced Negative, Neutral, Positive, and Compound scores of reviews, and these were stratified by demographic variables. Word frequency review was applied to determine popular words and phrases.

MAIN OUTCOME MEASURES

Star ratings, VADER Compound score of written reviews, and highest word frequencies.

RESULTS

A total of 203 glaucoma specialists and 3531 written reviews were assessed. Glaucoma specialists had an average of 4.26/5 stars, with a mean of 30 ratings per physician on Healthgrades. Most physicians (86%) had overall Positive written reviews (VADER = 0.74), indicating high patient satisfaction. Specialists who were women or had fewer years of practice had higher Compound and Star scores than their respective male and senior counterparts, with statistical significance observed between junior and senior physician Stars (P < 0.001). Repeated words pertaining to the surgery, staff, wait times, and questions were common overall and among the most positive and most negative reviews.

CONCLUSIONS

Glaucoma specialist patients value nonclinical factors, such as appointment setting and nonphysician health-care staff members, in their written reviews. Thus, factors beyond clinical outcomes are influential in the overall patient experience and should be considered to improve health-care delivery. These results can also advise ophthalmologists on factors that patients prioritize when evaluating physicians, which influences the decisions of other patients seeking glaucoma care.

FINANCIAL DISCLOSURE(S)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Validating the Effectiveness of the Patient-Centered Cancer Care Framework by Assessing the Impact of Work System Factors on Patient-Centered Care and Quality of Care: Interview Study With Newly Diagnosed Cancer Patients

BACKGROUND

Patients with cancer who have recently been diagnosed have distinct requirements compared to cancer survivors. It is crucial to take into account their unique needs to ensure that they make informed decisions and are receptive to the care provided.

OBJECTIVE

This study suggested a framework titled Effectiveness of Patient-Centered Cancer Care that considers the needs of newly diagnosed patients with cancer and related work system factors. This study investigated how work system factors influence the perceptions of patient-centered care, quality of care, and associated outcomes among newly diagnosed patients with cancer. Patient-centered care is defined in terms of workload and communication considerations, whereas the quality of care is assessed through indicators such as trust in physicians, satisfaction with care, and perceptions of technology.

METHODS

This study used qualitative data collected through interviews with newly diagnosed patients with cancer (N=20) right after their first visits with their physicians. Thematic analysis was conducted to validate the 5 hypotheses of the framework, mapping the interactions among quality of care, patient-centered care, and work system factors.

RESULTS

We found that workload and patient-centered communication impact the quality of care and that the work system elements impact the patient-centeredness (workload and communication) and the quality of care (trust in physicians, satisfaction with care, and perception of technology use).

CONCLUSIONS

Qualitatively validating the proposed Effectiveness of Patient-Centered Cancer Care framework, this study demonstrated its efficacy in elucidating the interplay of various factors. The framework holds promise for informing interventions geared toward enhancing patients' experiences during their initial visits after diagnosis. There is a pressing need for heightened attention to the organizational design, patient processes, and collaborative efforts among diverse stakeholders and providers to optimize the overall patient experience.

Healthcare Experiences of Black Patients During and After Pregnancy: a Needs Assessment for Provider Training to Improve Quality of Care

BACKGROUND

Black patients are at a higher risk of experiencing less safe and lower quality care during pregnancy and childbirth, compared to their White counterparts. Behaviors that healthcare professionals engage in that can facilitate or hinder high-quality care for this population are underexplored. We sought to explore Black patients' experiences with healthcare professionals during and after pregnancy, as a needs assessment to inform the development of training for healthcare professionals.

METHODS

We conducted semi-structured interviews of Black patients who were in their third trimester of pregnancy or within 18 months of giving birth. Questions focused on experiences with healthcare professionals during pregnancy-related healthcare, including quality of care and discrimination. Thematic analysis was conducted using a combined deductive-inductive approach. Findings were considered in the context of the Institute of Medicine's Six Domains of Quality (equitable, patient-centered, timely, safe, effective, efficient).

RESULTS

We interviewed 8 participants who received care from various clinics and institutions. Over half (62%) described experiencing discrimination or microaggressions during their pregnancy-related healthcare. Participants most commonly reflected upon experiences within the patient-centered care domain, regarding whether care was in alignment with their preferences, positive and negative interpersonal interactions, and varied experiences with patient education/shared decision-making.

CONCLUSIONS

Black patients commonly report experiencing discrimination from healthcare professionals during pregnancy-related healthcare. Reducing microaggressions and improving patient-centered care is a key focus for healthcare professionals who serve this group. Training needs include addressing implicit bias, educating on common microaggressions, improving communication, and promoting an inclusive workplace.

Raising patient voices in medical education: an assessment of patient perceived effect of social determinants of health conversations and the patient-physician relationship on quality of obstetric care, to inform the development of patient driven medical education curricula

Background

Conventional medical education lacks the lived experiences of patients which may authentically convey the social determinants of health (SDOH) and resulting health disparities. Videos of first-person patient narratives may prove a valuable education tool in this regard. The objective of this study is to investigate how patient demographics, satisfaction with care, and patient-physician relationships influence obstetric patient interest and willingness to contribute to a SDOH video curriculum by sharing their lived experiences through first-person narratives.

Methods

Study design included an anonymous, cross-sectional survey and an optional semi-structured telephone interview. Participants were 18 years old with a live-birth delivery <8 weeks prior to recruitment and received care during their pregnancy at Los Angeles General Medical Center (LAGMC). Variables surveyed included demographics, satisfaction with care, aspects of the patient-physician relationship, perceived utility, and personal interest in contributing to an educational SDOH video. A bivariate analysis was conducted to compare participants' characteristics and responses on interest in contributing and perceived helpfulness of first-person patient SDOH videos.

Results

72.43% of participants (N = 70) believed a patient's first-person video on SDOH would be "Helpful" in preparing physicians to provide competent medical care; however, 71.43% responded "No" to "Interest" in sharing with physicians their experiences with SDOH. English preference and being U.S. born were factors significantly associated with viewing first-person SDOH video as "Helpful" (P > 0.001). Major themes from telephone interviews reflected enthusiasm for first-person patient narratives and perceived benefits of using patient experiences to educate physicians on SDOH. However, participants cited barriers to disclosing SDOH including brief and strictly clinical interactions with physicians, lack of continuity of care, and fear of being judged by physicians.

Conclusion

While most participants recognized the utility of addressing social needs in medical education and reported satisfaction with their obstetricians and care, these factors did not uniformly translate into willingness to contribute first-person patient narratives. To improve the representation of patients from racial, ethnic, gender, linguistic, and sexual minorities into medical curricula, further research and strategies are needed to overcome the barriers discouraging patient disclosure of social needs to physicians.

Timing, Indicators, and Approaches to Digital Patient Experience Evaluation: Umbrella Systematic Review

BACKGROUND

The increasing prevalence of DH applications has outpaced research and practice in digital health (DH) evaluations. Patient experience (PEx) was reported as one of the challenges facing the health system by the World Health Organization. To generate evidence on DH and promote the appropriate integration and use of technologies, a standard evaluation of PEx in DH is required.

OBJECTIVE

This study aims to systematically identify evaluation timing considerations (ie, when to measure), evaluation indicators (ie, what to measure), and evaluation approaches (ie, how to measure) with regard to digital PEx. The overall aim of this study is to generate an evaluation guide for further improving digital PEx evaluation.

METHODS

This is a 2-phase study parallel to our previous study. In phase 1, literature reviews related to PEx in DH were systematically searched from Scopus, PubMed, and Web of Science databases. Two independent raters conducted 2 rounds of paper screening, including title and abstract screening and full-text screening, and assessed the interrater reliability for 20% (round 1: 23/115 and round 2: 12/58) random samples using the Fleiss-Cohen coefficient (round 1: k1=0.88 and round 2: k2=0.80). When reaching interrater reliability (k>0.60), TW conducted the rest of the screening process, leaving any uncertainties for group discussions. Overall, 38% (45/119) of the articles were considered eligible for further thematic analysis. In phase 2, to check if there were any meaningful novel insights that would change our conclusions, we performed an updated literature search in which we collected 294 newly published reviews, of which 102 (34.7%) were identified as eligible articles. We considered them to have no important changes to our original results on the research objectives. Therefore, they were not integrated into the synthesis of this review and were used as supplementary materials.

RESULTS

Our review highlights 5 typical evaluation objectives that serve 5 stakeholder groups separately. We identified a set of key evaluation timing considerations and classified them into 3 categories: intervention maturity stages, timing of the evaluation, and timing of data collection. Information on evaluation indicators of digital PEx was identified and summarized into 3 categories (intervention outputs, patient outcomes, and health care system impact), 9 themes, and 22 subthemes. A set of evaluation theories, common study designs, data collection methods and instruments, and data analysis approaches was captured, which can be used or adapted to evaluate digital PEx.

CONCLUSIONS

Our findings enabled us to generate an evaluation guide to help DH intervention researchers, designers, developers, and program evaluators evaluate digital PEx. Finally, we propose 6 directions for encouraging further digital PEx evaluation research and practice to address the challenge of poor PEx.